Below the Belt Award

Almost 80% of patients who are newly diagnosed with bladder cancers have tumours limited to the superficial layers of the bladder. The more aggressive forms of these superficial bladder cancers are commonly treated with an immunotherapy medication called BCG which is put into the bladder. This medication, an inactivated tuberculosis bacterium (BCG), has been used effectively for decades, reducing the likelihood of bladder cancer coming back or spreading outside the bladder. However, 30-45% of patients, this BCG treatment will fail with the cancer progressing into deeper layers or spreading outside the bladder despite treatment. If the cancer progresses to the bladder muscle despite BCG, even curative treatments such as removal of the bladder result in poor outcomes. Therefore, it is vital to identify patients who will not respond to BCG treatment early. BCG works by activating our immune system to target cancer cells in the bladder. Studies suggest that recruiting more immune cells in the cancer environment can benefit patients receiving BCG treatment. However, in patients who have an exaggerated inflammatory response with a large number of immune cells present before BCG treatment, it can cause exhaustion of these immune cells rendering these cells dysfunctional and unable to mount a response when BCG is administered. This study aims to utilise genetic pro-inflammatory gene markers and immunostaining to help identify which patients will not respond to BCG treatment. This will enable better selection of patients for this treatment and allow for future research to develop other therapies for bladder cancer.